Each contract between a prepaid limited health service organization and a provider or other person subcontracting for the provision of a limited health service to enrollees on a prepayment basis or any other basis must contain the following terms and conditions:
1. If the prepaid limited health service organization fails to pay for a limited health service for any reason, including, but not limited to, insolvency or breach of this contract, the enrollees are not liable to the provider for any money owed to the provider pursuant to this contract.
2. A provider, agent, trustee or assignee thereof may not maintain an action at law or attempt to collect from an enrollee any money which the prepaid limited health service organization owes to the provider.
3. These provisions do not prohibit the collection of any uncovered charges which an enrollee agreed to pay or the collection of any copayment from an enrollee.
4. These provisions survive the termination of this contract, regardless of the reason for the termination.
5. The termination of this contract does not release the provider from its obligation to complete any procedure on an enrollee who is receiving treatment for a specific condition for a period not to exceed 60 days, at the same schedule of copayment or any other applicable charge in effect when this contract is terminated.
6. Any amendment to the provisions of this contract must be submitted to the Commissioner for approval before the amendment is effective.
(Added to NRS by 1991, 1118)
Structure Nevada Revised Statutes
Chapter 695F - Prepaid Limited Health Service Organizations
NRS 695F.020 - "Enrollee" defined.
NRS 695F.030 - "Evidence of coverage" defined.
NRS 695F.040 - "Limited health service" defined.
NRS 695F.043 - "Medicaid" defined.
NRS 695F.047 - "Order for medical coverage" defined.
NRS 695F.050 - "Prepaid limited health service organization" defined.
NRS 695F.060 - "Provider" defined.
NRS 695F.070 - "Subscriber" defined.
NRS 695F.080 - General applicability of title 57 of NRS.
NRS 695F.090 - Applicability of chapter and other provisions.
NRS 695F.100 - Certificate required.
NRS 695F.110 - Application; fee.
NRS 695F.120 - Review of application; issuance of certificate.
NRS 695F.140 - Denial of application; hearing.
NRS 695F.150 - Evidence of coverage: Issuance; contents; amendment.
NRS 695F.160 - Rates and charges: Reasonableness.
NRS 695F.190 - Requirements for reserve.
NRS 695F.210 - Maintenance of fidelity bond or deposit in lieu of bond.
NRS 695F.212 - Hazardous financial condition: Regulations; determination; powers of Commissioner.
NRS 695F.230 - Establishment of system for resolution of complaints.
NRS 695F.310 - Examinations and investigations.
NRS 695F.330 - Payment of premium tax.
NRS 695F.360 - Violations of chapter: Order to cease and desist; fine.
NRS 695F.410 - Confidentiality and disclosure of information.